IMWG Guidelines for the Prevention of Thalidomide- and Lenalidomide-Associated Thrombosis in Myeloma

04.20.10

IMWG GUIDELINES FOR THE PREVENTION OF THALIDOMIDE- AND LENALIDOMIDE-ASSOCIATED THROMBOSIS IN MYELOMA1

The risk of VTE in cancer patients is greater than 7%; those with myeloma have the highest risk of thrombosis.2 The oral immunomodulatory drugs, thalidomide and lenalidomide, further increase that risk. The following guidelines from the International Myeloma Working Group recommend a prophylaxis strategy based upon a risk assessment model. The recommendations have been made in the absence of clear data from randomized studies, and are therefore based on common sense and on data extrapolated from many studies not specifically designed to answer these questions. Treatment decisions must be based on the type of therapy and the patient’s individual risk factors.

Risk factors for venous thromboembolism (VTE) in myeloma patients

Individual

Obesity (defined as body mass index > 30kg/m2)

Previous venous thromboembolism

Central venous catheter or pacemaker

Associated disease

Cardiac disease

Chronic renal disease

Diabetes

Acute infection

Immobilization

Surgery

General surgery

Any anesthesia

Trauma

Medications

Erythropoietin

Blood clotting disorders

Myeloma-related risk factors

Diagnosis per se

Hyperviscosity

Myeloma therapy (all are to be considered high-risk factors)

High-dose dexamethasone

Doxorubicin

Multiagent chemotherapy

Recommendations for VTE prophylaxis in myeloma patients based on risk factors
Both individual and myeloma-related risks of VTE should be taken into account in determining the type of thromboprophylaxis.

If no risk factor, or any one risk factor is present, aspirin 81-325 mg once daily is recommended.

If two or more risk factors are present, LMWH (equivalent of enoxaparin 40 mg once daily) or full-dose warfarin, international normalized ratio (INR) 2-3, is recommended.

If any myeloma therapy-related risk factor is present, then LMWH (equivalent of 40 mg enoxaparin once daily) or full-dose warfarin (target INR 2-3) is recommended.

Recommendations for VTE prophylaxis in myeloma patients based on type of therapy

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